Kidney Education Resources

We commit to:

• Treat you with respect

• Maintain your privacy and confidentiality

• Give you information and education about your condition, diagnosis, treatment and prognosis

• Explain the risks and benefits of treatment decisions

• Help you plan your care and set personal health goals that are important to you

• Provide you with continuity of care

• Listen and respond to your concerns

We ask you to:

• Attend all appointments

• Be available for a visit at your home by our Home Dialysis team

• Keep us informed so we can help you safely care for yourself

• Take responsibility for your treatment choices

• Respect other patients, visitors and our team

• Understand our hospital is a teaching and research centre

• If you need supplies call the Home Dialysis Unit at least 24 hours (1 day) ahead so that they are ready for you to pick up at the arranged time

The Home Dialysis clinic monitors your progress in terms of your treatment and the goals that you have set. The team can work with you to find ways to help you meet your goals or to change them as needed.

Clinic Visits

• The clinic is held at the St. Michael's Health Centre - 61 Queen Street East on the 9th floor.
• Follow up clinics are held on Tuesdays from 12:00 pm to 4:00 pm
• Please register when you arrive.
• You will attend a clinic every 8 weeks. You may come more often if needed.
• At the clinic, you will see your nurse, doctor, dietitian, social worker and pharmacist
• You should expect to be at the clinic for at least 2 hours each time you visit. Please be on time for your appointment.

Bloodwork

• Each time you come to the clinic, you will need to go to the lab to have blood taken.
• Your blood work will be done in the lab located in the same building as the clinic at 61 Queen Street East on the 1st floor
• The requisitions to get your bloodwork done will already be at the lab waiting for you
• Please come 30 minutes before your clinic time to have your bloodwork done. If you are late, please come directly to the clinic and go to the lab after your appointment.

• The Home Dialysis Unit is on the 8th floor of the Cardinal Carter Wing, Room 8-090

• We are open from 8:00 am to 4:00 pm, Monday to Friday

• If you need to speak to a team member, call (416) 864-5794. Please leave a message if no one answers. We will call you back as soon as possible.

• If your call is urgent and the clinic is closed, we have on-call staff that will answer your dialysis related questions

Nurses

• You will have a nurse assigned to you who will teach you how to safely do your own dialysis and manage your healthcare needs
• Your nurse will follow up with you, both at home and in the clinic, to see how you are managing your dialysis and any other healthcare concerns
• To contact your nurse or a member of the nursing team, call (416) 864-5794
• If you have any problems related to your dialysis, contact your nurse first. They will speak with your nephrologist for you if this is needed.

Nephrologist (Doctors)

• The two nephrology doctors working in the Home Dialysis program are: - Dr. Philip McFarlane & Dr. Jeffrey Perl
• They will review with you, your blood test results, blood pressure management and any medical care related to your dialysis
• Your doctor will see you during your clinic visits. Should your doctor be away, the other doctor will be available to you.
• If you have any problems related to your dialysis, contact your nurse first. They will speak with your nephrologist for you and then discuss with you.

Unit Secretary

• The unit secretary will answer your calls and help you contact your health care team when you have questions
• They will schedule both your clinic appointments and any other appointments that your nephrology doctor orders
• Please tell the secretary if you have any other appointments or blood working being done outside of St. Michael's, they can make sure that we have the results sent in before your next clinic
• It is extremely important to tell the secretary if there are any changes to your home address, health care or name so they can update your health record

Clinical Leader Manager (CLM) and Case Manager

• The managers works with your healthcare team to ensure that you have the best possible experience and the best care
• If you have any concerns about your care that you cannot resolve with your team of doctors and nurses, the managers will work with you and the team to help find the best and safest solution for your care needs

Dietitian

• A registered dietitian is an important member of your healthcare team
• Your dietitian will work with you to design a nutritional eating plan that gives you the right types and amounts of food so you can stay as healthy as possible
• Your dietitian can help you:
• Explain menu planning to help you adjust to a new way of eating
• Adapt your favourite recipes to better meet your nutritional needs
• Provide food lists that show contents like potassium, phosphorus and salt
• Teach you how to read food labels
• Monitor your nutritional needs over time
• Help you combine your kidney diet with other special diets you may be on

Social Worker

• Social workers are trained professionals who work with you and the team to provide counseling and other services for you and your family
• Some common patient concerns are:
• The impact of kidney disease and dialysis treatments
• Changes and adjustments resulting from illness and treatment
• Finances, transportation, housing, work-related issues, medication costs and other expenses
• Managing at home
• Understanding and managing grief and loss
• Support children in understanding and managing reactions to illness in the family
• Social work services for you and your family include:
• Counseling to help you adjust emotionally to your illness, treatment crisis, grief and bereavement
• Counseling, referral and linking to community or hospital resources
• Help filling out forms or application
• Education on the effects of disease, illness and treatment
• Consulting and collaborating with other members of the team and community services

Pharmacist

• The pharmacist works with you and your healthcare team to make sure you have all the medications you need, in the correct dose, to make sure you have the best possible health journey
• They will watch how your medications affect you
• They will teach you about each drug you take and why it is important to take them as they are prescribed to you
• Bring all your medications, including over-the-counter medication and any herbal products you may be taking to each clinic visit
• They will meet with you to:
• Review your medication and make sure they are right for you
• Review any changes to your medication
• Teach you about any new medication you are prescribed. They will talk to you about the reason for the new drug, how and when it should be taken and any side effects or drug interactions that might occur.
• Give you a medication list if you would like one
• Help organize your medication if you are going to be traveling

Goal Setting

• Setting goals is important to help you have the confidence to manage your care
• Your team is available to help you with planning and making a list of your goals so that they are personal to you
• Some key things to think about when thinking of your goals. Goals should be:
• Specific - Clearly state what you want to do, where you will do and by when. Keep your goals simple and limit each goal to one idea
• Measurable - Choose a method that will let you know that you met your goal
• Attainable - Make sure that you are able to do what you set out to do
• Relevant - Choose goals that are important to you and your care
• Timely - Give yourself a reasonable time frame to meet your goal

• Ontario Renal Network - Fact Sheets

Dialysis Prescription

Generally, your dialysis prescription remains the same for a while but the number and/or volume of exchanges prescribed may increase over time as your urine output decreases. Your nurse or nephrologist will discuss this with you.

You will be informed of how many exchanges you need to do by your nephrologist. Generally it is 3 to 4 exchanges per day.

Try to do exchanges at regular intervals throughout the day about 4 to 6 hours apart

CAPD is flexible so fit your exchanges into your schedule

Example:

Dialysis Prescription

Generally, your dialysis prescription remains the same for a while but the number and/or volume of exchanges prescribed may increase over time as your urine output decreases. Your nurse or nephrologist will discuss this with you.

Automated peritoneal dialysis (APD) involves using a small portable cycler machine that will provide the dialysis to you. This will allow you to do your dialysis at night time while you are sleeping. Its is programmed to do the dialysis exchanges at a set time.

The type of APD prescribed for you will take into consideration your physical, personal and caregiver needs. There are several programs available on the cycler machine to be able to give you the dialysis prescription as ordered by your nephrologist.

Your nurse will help you to program your machine based on your prescription.

Your nurse will also teach you the information that you require to perform your treatment safely.

If your prescription changes, your nurse will work with you to change your machine program.